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Passport to Slim: Weight Loss Secrets from Around the World

North Americans may be many things, but one thing we’re not? Svelte. Not on average, anyway. And certainly not compared to the rest of the world. Are there things we could learn from our friends in other countries around the globe? Why, yes. Yes there are. Join me on a little tour.

Japan

In Okinawa, Japan, they eat using this principle: hara hachi bu. Roughly translated, it’s an instruction to eat until you’re 80% full. And it’s an excellent practice to live by. There’s no reason to eat until you’re stuffed. Also, there’s a delay in the message from your stomach to your brain that signals “full”. By the time you register that you’ve had enough…you’ve already overdone it.

India

This is the birthplace of yoga, of course. I’m a big fan of yoga; there are a multitude of health benefits for taking up the practice. And a slimmer physique happens to be one of them. A recent study showed that long-term yoga participants have lower BMIs than other exercisers. Perhaps it’s the mindfulness training that does the trick. Because here’s what happens when you engage in Mindless Eating.

France

Well, you know what they say: French women don’t get fat. I’m not sure anyone has fully figured out this (highly irritating) mystery…but I have some thoughts. I imagine it has to do with portion control, taking pleasure in food, and long leisurely meals together with friends & family. Oh, and chocolate for breakfast.  

Greece

It’s not entirely unique to the sun-soaked people of Greece, but the Mediterranean Diet is one we can all embrace, to improve our heart health, our waistlines, and our pleasure in food. Olives? Wine? Garlic? Yes please.

Brazil

To understand why it makes sense to eat like a Brazilian, think Gisele. Think thong bikinis on the beaches of Rio. A staple on the Brazilian table is rice-and-beans. It’s a low-fat, high-protein, high-fiber choice, which helps stabilize blood sugar. A study in Obesity Research examined the Brazilian diet in detail and found that a traditional diet mainly consisting of rice and beans lowers the risk of being overweight by about 14%.

Italy

All over Italy, in cities and small villages alike, la passegiata is an enduring tradition. It’s an informal stroll around town each evening before, or after, the family dinner. Italians promenade the streets, socializing, getting fresh air and a little exercise before settling in for an evening. To my mind, it certainly beats plopping on the couch to break open a bag of chips and stare at another episode of The Bachelor.

Thailand

All that spicy stuff in Thai curries and noodle dishes means there’s plenty of capsaicin in the Thai diet. That’s the substance that makes food hot…and it not only boosts metabolism, but also: you simply can’t gobble down spicy food at the same rate you can a cheeseburger. Fiery food means slower eating. And that’s a good thing for weight loss.

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On My Bookshelf: Mindless Eating

How much free, stale popcorn would you eat in a movie theater? Does it depend if it’s served in a medium-sized bag or a jumbo tub? And what about candy: how much would you eat if it was sitting on your desk? Would it matter if the glass dish was opaque or clear? If it had a lid? 

Well, the person who knows the answers to all those questions, and more, is Brian Wansink, Ph.D. And he compiled all those answers in a fantastic book called Mindless Eating: Why We Eat More Than We Think.

This is a man who has made a career studying the feeding and foraging habits of the species knows as…well, us. And, quite frankly, it’s pretty shocking. And perhaps a little depressing. Turns out we are sheep, people, spineless sheep when it comes to being suckered into eating more. Give us bigger containers, we’ll gobble more. Move those containers closer to us, we’ll scarf down more. Sit us in front of a television? Yep, more.

But the point isn’t to be entertained with tales of secretly refillable soup bowls (yes–you will mindlessly eat more soup if your bowl magically refills) and sneaky wine bottle labels (yes–you will linger in a restaurant and eat more food if you think it’s a more prestigious vintage). The point is to learn how to harness these psychological phenomena for good rather than evil.

As Wansink says: “our stomachs are bad at math”. We are terrible at keeping track of how much we’ve eaten. Was it 30 french fries or 20? The thing is, over time, it makes a difference.

What’s scary: nobody seems immune to the things that trick us into overeating. Some of Wansink’s sneakiest studies were done on people who should have known better. Like graduate students who just attended a lecture on this stuff. Turns out they will shovel more Chex Mix into their faces if served from larger bowls than from smaller bowls, just like the rest of us would.

But the good news is that you can actually use this information to improve your eating habits. Wansink talks about the Mindless Margin:

If we eat way too little, we know it. If we eat way too much, we know it. But there is a calorie range–a mindless margin–where we feel fine and are unaware of small differences.

Over the course of a year, the mindless margin can cause us to lose 10 lbs or gain 10 lbs. Totally unaware. For example, when people pre-plate their food, they eat about 14% less than when they take smaller amounts and then go back for seconds or thirds. So, make a habit of pre-plating!

This book is brilliant. There are so many fascinating tidbits and ideas–more than I can describe here. Personally, I’m always a fan of a good jedi-mind trick that helps you lose or maintain weight without feeling the pain of deprivation. As Wansink says: “the best diet is the one you don’t know you’re on”.

Hear, hear.

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Get Healthy With Olive Oil, Tomatoes, and Wine

I’ll admit it: I’m a little obsessed with Europe. In the past I’ve written about the French Paradox , and there’s a big part of me that would like to be reborn in this life as a French woman (and not only because spa treatments are considered part of the French healthcare system). Also, I could very easily live the rest of my life in London, drinking tea and taking weekend trips to Paris and Tuscany.

But lately I’ve been researching and reading about the Mediterranean diet, and I’m growing convinced that it’s the way to go. Not as a short-term weight loss plan, per se (although it does appear to help with that), but more as a long-term way of life. And that’s because the evidence is overwhelming that it can lead to a longer, healthier life.

And who doesn’t want that?

The research in favor of the Mediterranean diet is huge-ola. Much of it surrounds the impressive benefit to our hearts. A meta-analysis published in the American Journal of Medicine this month analyzed the results of several studies that pitted the Mediterranean diet and low-fat diets head-to-head. They found that the Mediterranean diet was more effective for weight loss than a low-fat diet, and brought greater improvements to blood pressure, blood sugar, and cholesterol.

The Mediterranean diet has also been shown to protect against the “big C”: many studies have shown the Mediterranean diet to reduce cancer risk.

The British Medical Journal published a big study a couple of years ago, concluding that the Mediterranean diet is associated with “a significant improvement in health status”, specifically: a reduction in overall mortality (9%), mortality from cardiovascular diseases (9%), cancer (6%), and incidence of Parkinson’s disease and Alzheimer’s disease (13%).

Convinced yet?

So what, exactly, do you eat if you’re trying to go Mediterranean?

  • real food, for starters
  • an emphasis on plant-based food: vegetables, fruit, whole grains and legumes
  • limited red meat, but plenty of poultry and fish
  • olive oil (pretty much replacing all your other fats, like butter)
  • nuts
  • fresh, seasonal food
  • wine in moderation
  • no eliminated food groups (except twinkies)

There’s much more detail out there, of course, if you’re interested. A wonderful resource for all things Mediterranean diet is Oldways. This is an organization on a mission to raise awareness about the health benefits (and joy) of this ancient way of eating.

When my husband and I were in Italy a few years ago, we made bruschetta in our little kitchen pretty much every day: fresh bread, fresh tomatoes, garlic, basil, olive oil and salt…and if there’s a better taste combination out there, I’d like to find it. Sometimes, the simpler the food, the better.

Besides all the research, I am personally convinced that eating a Mediterranean diet is an effective way to adopt a healthy lifestyle for one other important reason: it is pure pleasure. And, therefore, something you’d be not only willing to do long-term, but happy to do. 

Sure, there may be other ways you could improve your health and live longer. I happen to not believe there is one perfect diet for everyone. Some people may be able to stick to Dr. Esseltsyn’s ultra-low-fat/vegan diet , as an example. In fact, I have little doubt that if you really could stick to this kind of nutrition plan, your heart would be healthier. But for most of us, it would involve just too much sacrifice. And if you’ve been reading this blog for anything longer than five minutes, you’ll know that I’m all about enjoying life, enjoying food, and indulging whenever possible .

The mediterranean diet fits this bill perfectly.

Losing Weight the French Way: Weighing In On The Dukan Diet

Everywhere I look these days I see something about the Dukan Diet. it’s the diet that, famously, Kate and her mother went on prior to the Royal Wedding. And it’s touted as the new French woman’s secret. Apparently it swept Europe after it was first published in 2000, and now it’s come to North America. I also read a claim that it was similar to Atkins but with a few key changes (like a “healthier Atkins”).

With all this attention, I decided I really had to look into it.

So I bought the book, read it completely, and here’s my summary:

Pierre Dukan is a French physician who developed his diet over 35 years in clinical practice.There are four phases to the diet.

1)The Attack Phase. This is where you eat what he calls “pure protein”. Only lean meat, poultry, fish, and eggs, nonfat dairy, and tofu. Plus 1 1/2 tbsp oat brain daily, at least 1 1/2 quarts water daily, and a 20 minute walk every day. The idea here is to kick-start your weight loss and give you some positive reinforcement. This phase lasts 2-7 days.

2)The Cruise Phase. Here you alternate 1 pure protein day with 1 protein + vegetables day (but not starchy eg, like potatoes, corn, and lentils). Plus oat bran (now 2 tbsp) and 30 minutes of walking daily. You stay on this diet until you’ve reached your target weight. Dukan reports that you should expect to lose around 2 pounds per week, although the weight loss may be faster in the initial stages of this phase. 

3)The Consolidation Phase. He also calls this the Transition Diet. The idea here is a very slow transition back to your “normal” or long-term eating plan. He says that this is a crucial phase, and ignoring this step (on any diet) is the reason so many people have rebound weight gain. The duration of this phase is 5 days for every pound you lost on the diet. Essentially, you’re slowly re-introducing the foods you eliminated from the first two phases. So what are you eating? All protein and vegetables from the previous phase, plus one serving of fruit per day, 2 slices of whole grain bread per day, 1 1/2 ounces of cheese per day, and 2 servings of starchy food per week. Plus 2 “celebration meals” per week, and 1 day of pure protein per week.

4)The Permanent Stabilization Phase. This is the eating plan you are supposed to maintain for life. It’s pretty simple: you eat “normally” 6 out of 7 days per week. Each week you have one day of pure protein, just like in the Attack Diet. He has three other guidelines: 1)no escalators or elevators. 2) eat 3 tbsp of oat bran a day. And 3) “Hold on to everything you have learned and the good habits you have acquired while completing the whole program”.

So after reading the book, I looked for some evidence or research that might have been done on this particular diet. And there was nothing. Nobody has researched the Dukan diet, specifically. Not even Dukan himself. Okay, well, except from his observations while using this diet with his patients for 35 years. But this experience is all anecdotal and observational. Which isn’t terrible, just not exactly rigorous research. But just because there isn’t a lot of research on something, doesn’t necessarily mean it’s bad. It could just mean scientists haven’t had a chance to study it yet. The truth–good or bad, or both–will come out eventually. But that doesn’t help us in the here and now.

There is rigorous research, on the other hand, for the general principle of low-carb diets. They are effective for weight loss, that much we know. And that’s Dukan’s underlying principle: low (or no) carb, and high protein.

The most radical part of this diet is the Attack Phase, where he advocates protein only. And this is where dietitians seem to get a little nervous (or scream & shout). But, the thing is, that phase only lasts 2-7 days. That’s pretty brief. If you’re generally healthy, it’s hard to imagine you doing any major damage to yourself in such a short time. Especially if you follow his advice and drink tons of water. After that, the alternating protein diet, he’s got you eating plenty of vegetables, which is a very healthy thing. And he emphasizes lean protein–which, to my mind, is a good thing (better than a bacon-cheese-egg diet which is a common interpretation of Atkins, the Zone, etc). The third phase is where I have a few more concerns. In principle, I think a very slow transition phase to allow your body to stabilize after weight loss is a great idea. But the rules in this phase are complicated, and I wonder how many people will be able to follow it properly. Also, going for so long with so little fruit has me worried, too. The fourth phase, for long-term maintenance, seems to be pretty sound. Again, I don’t think most people would be harmed by a protein day once a week. I’m just not sure it would be enough to keep people from regaining weight over the long-term. A lot would depend on what they’re eating the other days of the week.

Bottom line for me: I think this diet might work for weight loss for some people. The rules of the weight loss phases are pretty simple, and keeping things simple is very helpful for adherence to a diet. I’m going out on a bit of a limb here, given that my profession is evidence-based, and this diet is anything but. It’s pretty radical to go so low-carb, and not something I would advocate long-term. Vegetarians would have a difficult time with this diet. And I would not recommend it for anyone who isn’t generally healthy, especially people with kidney disease, and certainly not for pregnant/breastfeeding women or children. 

I guess what it comes down to is weighing the costs and the benefits. Do the benefits of weight loss to a person’s health, especially if they are obese (and thus at high risk of heart disease, cancer, diabetes…well-documented stuff), outweigh the possible (and as yet, not exactly known) risks of a radical diet in the short-term? If a diet like this helps someone who is destined for bad health consequences down the road, is it worth the short-term complications (like constipation and bad breath on a high-protein diet)? Lots of questions, not a lot of answers at this point (from a research point of view). But, as with so many things, I think it comes down to individual factors–what works for one person may be a terrible idea for another. And vice versa. 

Anybody have any experience with the Dukan Diet? I’d love to hear about it.

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Detox Diets & Cleanses: What’s The Deal?

A friend of mine recently told me she’d done a “cleanse” that lasted 9 days. It cost her $150. It involved a regime of supplemental shakes and powdered cleansing drinks (this product was the reason for the $$), fasting days of only juice and water, alongside other recommended dietary changes. The main claims? Weight loss, cleansing the body of toxins, improved energy and digestion.

My friend is hardly the first person to go on such a regime. It seems like, these days, every other celebrity is talking about this, and I’ve had countless patients tell me they’re “doing a cleanse”.

So here’s my question: Do detox diets and cleanses actually benefit your health? Do they live up to their claims?

Or, put another way: does a detox diet cleanse anything other than your wallet?

My friend said, after the 9 days, she felt great, and she had lost “inches”. And this wasn’t the first time she’d done this particular cleanse. She was telling me this, of course, as we munched our way through a big tub of movie popcorn. Had she changed her diet long-term? Nope. The last few times she’d done this cleanse she’d also lost weight, and inches, and felt great. Had she regained the weight each time? Yep.

So, naturally, as we talked I was formulating an opinion on this particular diet, but I decided I needed to do some research. Here are the positions of some reputable institutions on “detox-ing”:

TIME Health

Mayo Clinic

Harvard Health

Essentially, what everyone seems to say is this: there’s no evidence to support these sorts of “cleanses” or “detox diets”. But does that mean there hasn’t been sufficient research done yet? Or does it mean there is definite evidence against it? That bit is a little unclear.

I think it’s helpful to tease out the reasons for using a cleanse. And there appear to be two different camps. One primary goal is to rid the body of toxins. The other is to lose weight. There are all sorts of side-benefits mentioned in these programs, but as far as I can tell, these are the two primary goals. And they can be considered separately.

The consensus is pretty clear on the weight loss goal: it will work, but it will be short-lived, and you will likely have rebound weight gain–often more than your initial loss. See, the thing is, your metabolism is now slower. Your body has gone into starvation mode.

As for the detoxification goal, I think this one is still up for debate. I do believe that our bodies need detoxification. But the fact is, we were born with internal systems designed to do this job for us (liver, kidneys, and skin, via sweating). However, whether these systems are sufficient for this job in our modern age, and with our North-American-ized diet, is perhaps not totally certain.

I really, really wish I’d been able to find some solid scientific studies on this topic. But I didn’t. I’m going to keep checking, and maybe something will be forthcoming. As Dr. Marc Cohen, Professor of Complementary Medicine, in a paper that reviewed detox diets (in Australian Family Physician) said: “lack of evidence for an effect does not mean lack of effect”. Which is quite true.

That being said, I would personally expect there to be some pretty convincing evidence available to prove a system’s effectiveness before shelling out $150.

Here are some prominent physicians’ viewpoints:

Dr. Andrew Weil

Dr. Mark Hyman

Here is what Dr. Weil said about cleansing/detox-ing diets:

Fasting and near-fasting routines such as the Master Cleanse are not effective weight loss tools – they alter your metabolism in a way that actually may make it harder for you to lose weight or easier to regain the weight once you go back to the way you normally eat. Most people compensate for the deprivation of the regimen by increasing their caloric consumption afterward.

I mean, if someone like Dr. Weil doesn’t even endorse this kind of thing (and he’s a fan of some pretty out-there stuff sometimes), it’s quite likely you’ve really got something pretty ineffective on your hands.

I have little doubt there’s a placebo effect to these pre-packaged detox systems. I mean, you’ve got a vested interest in believing that something is working when you’ve forked over a big chunk of your paycheque, don’t you?

The diet system my friend used also required that she eliminate dairy, meat, alcohol, and caffeine from her diet during the 9 days. And drink plenty of water. I asked her what she thought might happen if she tried just doing the diet cleanup part, without all the pricey shakes. Any chance she might feel better, slim down, have more energy…all without the hyped-up product?

And I guess that’s my opinion in a nutshell. If you’re looking to detox from junk food and processed food and all those other toxins…how about not eating junk food and processed food? How about having a healthy, bountiful diet of whole food? How about drinking plenty of water anyway? How about exercising, and sweating, and getting lots of sleep?

Hmm.

Any thoughts? Anybody have any experiences doing a cleanse?

The Skinny on: The Sonoma Diet

This post is part of a regular feature I’ve got planned: reviews of popular diets. If there’s a diet you’d like me to review, send me a message, or use the comments below!

So…the Sonoma Diet. This was created by Dr. Connie Guttersen, a registered dietitian with a Ph.D in nutrition who lives in California.

Essentially, this is a diet inspired by the Mediterranean diet and lifestyle…with a weight-loss spin, and a nod to the cuisine of the California wine region Sonoma valley. (sidebar: love Sonoma; it’s where I got engaged. If you get a chance, you gotta visit!)

What I like about the Sonoma Diet:

For starters, recommending the Mediterranean diet is a solid approach. There’s heaps of research showing that the Mediterranean diet is supaah for your health. It lowers your rate of heart disease, cancer…all sorts of nasty stuff. It seems like every other day I come across another study touting the benefits of the Med diet.

Guttersen uses a “plate-and-bowl” concept for her diet, which I like. Super-easy to use, no-brainer and zero time involved. No counting calories or anything else. Just fill your plate or bowl according to simple percentages (think pie chart), depending on the meal. For example, in Wave 1: for dinner, use a 9 inch plate, and fill it with 30% protein, 20% grains, 50% veggies.

I like the lifestyle approach–the emphasis on whole foods and the enjoyment and pleasure of food. Too many diets are restrictive and, frankly, miserable. A recipe for cheating if you ask me. The Sonoma Diet is the opposite of this. (Very much in keeping with my Wicked Healthy philosophy, incidentally).

Guttersen frequently mentions the health benefits of this diet beyond simply losing weight, which is fab. It’s important to keep bigger health goals in mind beyond just looking good in a bikini. Like reducing heart disease, decreasing inflammation, preventing cancer. Guttersen repeatedly stresses the importance of power foods like olive oil and tomatoes (yum!)…foods that are loaded with nutrients and antioxidants.

Perhaps my fave part of this diet is that you’re encouraged to drink a glass of wine every day. Every. Day. Love it.

What I don’t like about the Sonoma Diet:

I’m not so crazy about the de-emphasis on cheese and dairy. I’m a fan of dairy. It’s a great source of protein, calcium…all sorts of goodies.

There’s no modification of the diet for men, for women, for people larger or smaller than average, or for varying activity levels. One-size-fits-all portions and proportions don’t make a lot of sense to me. Granted, there’s a little of this, when she mentions snacks, but not enough.

The meal plans are primarily structured around Breakfast, Lunch, and Dinner. To me, there should be more snacks. I think diets (and healthy eating, in general) works best if there are structured snacks between meals. Eating every 3 hours or so to keep blood sugar from doing major spikes and dips is the way to go. She really only says “you may” have a snack to tide you over.

The diet completely nixes sugar (including fruit) in Wave 1, and the idea is so you can “eliminate” sugar cravings by the end of those 10 days. And here’s where she loses me. I’m highly skeptical than anyone can forevermore lose their cravings for sugar by simply not having sugary stuff for 10 days. Pinning your hopes on this fantasy is a setup for failure. You really need to have a more realistic way of approaching sugar cravings.

In the third part of the diet, which starts after you’ve reached your target weight, Guttersen gets a little thin on the advice. I kinda felt like I’d been left to fend for myself here, and would have appreciated more specific guidelines and strategies in the maintenance phase.

I Would Recommend the Sonoma Diet for…

People who love food, love flavors, and love to linger over meals. (hmm…is there anyone who doesn’t fit into this category?)

People who enjoy cooking (and have time to cook). A key part of the diet is making your own meals. Granted, the recipes look/sound absolutely mouthwatering. But ya gotta have the time to make them.

People who aren’t looking for quick-fix, fad-type solutions to weight loss.

People who don’t want to count calories, look up GI points, or do any other food math.

Basically, I’m a big fan of this diet.

Big.

Dr. Kim Foster, MD. (photo credit: Tamea Burd Photography)

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